(641) Pre-Treatment Corticosteroids on Survival in Head and Neck Cancer Treated with Immune Checkpoint Inhibitors

Introduction: Corticosteroids are frequently prescribed to patients with head and neck cancer (HNC). However, their immunosuppressive effects may blunt the efficacy of immune checkpoint inhibitors (ICIs). Studies have shown that Corticosteroids administered with ICI have worse overall survival (OS) across multiple cancer types. This study evaluated the impact of pre-treatment corticosteroid exposure on overall survival in patients with HNC treated with ICIs.

Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Patients with HNC treated with ICIs (pembrolizumab, nivolumab, cemiplimab, or durvalumab) were stratified based on systemic corticosteroid exposure (prednisone, methylprednisolone, hydrocortisone, dexamethasone, or prednisolone) within three months before or up to one day after ICI initiation. Patients with prior organ transplantation, hematologic malignancies, or immunodeficiency were excluded. Propensity score matching (1:1) was performed to balance demographics, comorbidities, tobacco and alcohol use, oncologic histology, tumor site, chemotherapy, radiation therapy, immunodeficiencies, and surgical history. Overall survival was assessed using Kaplan–Meier analysis and Cox proportional hazards modeling.

Results: After propensity score matching, each cohort included 1,726 patients. Patients without corticosteroid exposure demonstrated better 5-year OS than corticosteroid-exposed patients (median survival 610 vs. 482 days). Survival probability at five years was higher in the non-steroid group (35.16% vs. 29.66%). Baseline corticosteroid exposure was associated with significantly worse survival at 1, 3, and 5 years (5 year: hazard ratio 0.86, 95% CI 0.78–0.95; log-rank p=0.003).

Conclusions: Pre-treatment corticosteroid exposure is associated with inferior overall survival in patients with head and neck cancer treated with ICIs. These findings suggest corticosteroid use around ICI initiation should be minimized when clinically feasible and highlight the need for prospective studies to clarify optimal management strategies.